<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Deviceid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-deviceid" data-rule="required" class="form-control" name="row[deviceid]" type="text" value="{$row.deviceid|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" data-rule="required" class="form-control" name="row[phone]" type="text" value="{$row.phone|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">所属小区:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="form-inline" data-toggle="cxselect" data-selects="province,city,area,town,subdstrict">
                <select class="province form-control" name="row[province_id]" data-url="ajax/area" data-live-search="true">
                    <option value="{$row.province_id|htmlentities}"></option>
                </select>
                <select class="city form-control" name="row[city_id]" data-query-name="province" data-url="ajax/area" data-live-search="true">
                    <option value="{$row.city_id|htmlentities}"></option>
                </select>
                <select class="area form-control" name="row[region_id]" data-query-name="city" data-url="ajax/area" data-live-search="true">
                    <option value="{$row.region_id|htmlentities}"></option>
                </select>
                <select class="town form-control" name="row[town_id2]" data-query-name="region" data-url="ajax/onlycommu" data-live-search="true">
                    <option value="{$row.town_id2|htmlentities}"></option>
                </select>
                <select class="subdstrict form-control" name="row[subdstrict_id]" data-query-name="town" data-url="ajax/onlysubds" data-live-search="true">
                    <option value="{$row.subdstrict_id|htmlentities}"></option>
                </select>
            </div>
        </div>
    </div>
    <!--<div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sos1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sos1" class="form-control" name="row[sos1]" type="text" value="{$row.sos1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sos2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sos2" class="form-control" name="row[sos2]" type="text" value="{$row.sos2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sos3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sos3" class="form-control" name="row[sos3]" type="text" value="{$row.sos3|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Stepswitch')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-stepswitch" min="0" class="form-control" name="row[stepswitch]" type="number" value="{$row.stepswitch|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Locationtimeinterval')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-locationtimeinterval" class="form-control" name="row[locationtimeinterval]" type="text" value="{$row.locationtimeinterval|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Heartratetimeinterval')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-heartratetimeinterval" class="form-control" name="row[heartratetimeinterval]" type="text" value="{$row.heartratetimeinterval|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Maxheartrate')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-maxheartrate" class="form-control" name="row[maxheartrate]" type="text" value="{$row.maxheartrate|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Minheartrate')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-minheartrate" class="form-control" name="row[minheartrate]" type="text" value="{$row.minheartrate|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bphighmax')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bphighmax" class="form-control" name="row[bphighmax]" type="text" value="{$row.bphighmax|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bphighmin')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bphighmin" class="form-control" name="row[bphighmin]" type="text" value="{$row.bphighmin|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bplowmax')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bplowmax" class="form-control" name="row[bplowmax]" type="text" value="{$row.bplowmax|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bplowmin')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bplowmin" class="form-control" name="row[bplowmin]" type="text" value="{$row.bplowmin|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bloodoxmax')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bloodoxmax" class="form-control" name="row[bloodoxmax]" type="text" value="{$row.bloodoxmax|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Bloodoxmin')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-bloodoxmin" class="form-control" name="row[bloodoxmin]" type="text" value="{$row.bloodoxmin|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Tempmax')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-tempmax" class="form-control" name="row[tempmax]" type="text" value="{$row.tempmax|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Tempmin')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-tempmin" class="form-control" name="row[tempmin]" type="text" value="{$row.tempmin|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname1" class="form-control" name="row[pbname1]" type="text" value="{$row.pbname1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book1" class="form-control" name="row[book1]" type="text" value="{$row.book1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname2" class="form-control" name="row[pbname2]" type="text" value="{$row.pbname2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book2" class="form-control" name="row[book2]" type="text" value="{$row.book2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname3" class="form-control" name="row[pbname3]" type="text" value="{$row.pbname3|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book3" class="form-control" name="row[book3]" type="text" value="{$row.book3|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname4')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname4" class="form-control" name="row[pbname4]" type="text" value="{$row.pbname4|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book4')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book4" class="form-control" name="row[book4]" type="text" value="{$row.book4|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname5')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname5" class="form-control" name="row[pbname5]" type="text" value="{$row.pbname5|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book5')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book5" class="form-control" name="row[book5]" type="text" value="{$row.book5|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname6')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname6" class="form-control" name="row[pbname6]" type="text" value="{$row.pbname6|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book6')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book6" class="form-control" name="row[book6]" type="text" value="{$row.book6|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname7')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname7" class="form-control" name="row[pbname7]" type="text" value="{$row.pbname7|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book7')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book7" class="form-control" name="row[book7]" type="text" value="{$row.book7|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname8')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname8" class="form-control" name="row[pbname8]" type="text" value="{$row.pbname8|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book8')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book8" class="form-control" name="row[book8]" type="text" value="{$row.book8|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname9')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname9" class="form-control" name="row[pbname9]" type="text" value="{$row.pbname9|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book9')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book9" class="form-control" name="row[book9]" type="text" value="{$row.book9|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pbname10')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pbname10" class="form-control" name="row[pbname10]" type="text" value="{$row.pbname10|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Book10')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-book10" class="form-control" name="row[book10]" type="text" value="{$row.book10|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicine1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicine1" class="form-control" name="row[medicine1]" type="text" value="{$row.medicine1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicinename1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicinename1" class="form-control" name="row[medicinename1]" type="text" value="{$row.medicinename1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('M1')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-m1" min="0" class="form-control" name="row[m1]" type="number" value="{$row.m1|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicine2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicine2" class="form-control" name="row[medicine2]" type="text" value="{$row.medicine2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicinename2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicinename2" class="form-control" name="row[medicinename2]" type="text" value="{$row.medicinename2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('M2')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-m2" class="form-control" name="row[m2]" type="number" value="{$row.m2|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicine3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicine3" class="form-control" name="row[medicine3]" type="text" value="{$row.medicine3|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicinename3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicinename3" class="form-control" name="row[medicinename3]" type="text" value="{$row.medicinename3|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('M3')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-m3" class="form-control" name="row[m3]" type="number" value="{$row.m3|htmlentities}">
        </div>
    </div>-->
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
